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Elevation of white blood cells(WBCs) is associated with worse outcomes in patients with coronary artery disease(CAD), including patients undergoing percutaneous coronary intervention(PCI) of native coronary arteries, but this relation has not been studied in patients with saphenous vein graft disease undergoing PCI. A total of 530 patients who underwent PCI of saphenous vein grafts from May 1997 to July 2002 were followed for >3 years. Major adverse coronary events(MACEs) were assessed as a composite of death, myocardial infarction, or revascularization during follow-up(mean 2.7 years). Patients with MACEs(n=287) were younger and had more thrombotic and ostial lesions(p< 0.05) than those without MACEs(n=243). The preprocedural WBC count was also significantly higher in the MACE group than in the non-MACE group(8.1×103/μl, range 6.6 to 10.1, vs 7.0×103/μl, range 5.6 to 8.2; p< 0.001). After adjusting for covariates, multiple logistic regression analysis revealed the preprocedural WBC count to be an independent predictor for MACEs(odds ratio 1.2; 95%confidence interval 1.1 to 1.3, p< 0.001). Patients in the highest quartile of the preprocedural WBC level had a significantly increased risk of MACEs(lowest vs highest quartile, 41.3%vs 72.4%; odds ratio 3.7; 95%confidence interval 2.2 to 6.3). Thus, an elevated preprocedural WBC count is associated with increased risk of MACEs in patients undergoing PCI for saphenous vein graft lesions.